This proposal describes the career development program of David L. Sultzer, M.D., and requests two additional years of support by the Clinical Mental Health Academic Award in Geriatric Psychiatry. Dr. Sultzer received the three-year Academic Award in 1991. Accomplishments during the initial three years of the program at UCLA include: 1. Research productivity. The severity of specific psychiatric symptoms in 61 patients with Alzheimer's disease (AD) has been examined. A comparison of psychiatric symptoms in patients with AD and those with vascular dementia has shown that depression, anxiety, and behavioral retardation are more severe in patients with vascular dementia. A positron emission tomography (PET) study has shown that cortical hypometabolism is associated with both cognitive and noncognitive psychiatric symptoms in patients with AD. Preliminary evidence suggests that hypometabolism in the frontal cortex contributes prominently to agitation and psychotic symptoms. Results from these studies have been presented at national meetings and are currently published, in press, or in submission. 2. Academic development. Dr. Sultzer has gained basic skills in PET imaging techniques, has completed coursework in biostatistics and research design, and has advanced his teaching skills. He is regarded as a promising academic leader in geriatric mental health. The proposed two-year program builds on the research progress and the academic skills that were developed during the initial Award period. Specific goals are: 1) to examine the mental health consequences of frontal lobe dysfunction in patients with AD, and 2) to gain advanced research skills in PET imaging and data analysis. The following activities are proposed to achieve these goals. 1. Dr. Sultzer will implement the research project: Frontal Lobe Dysfunction in Alzheimer's Disease. This study examines the longitudinal course of frontal hypometabolism in AD and tests the hypothesis that the progression of specific psychiatric symptoms in AD is associated with metabolic reduction in the frontal cortex. The study also examines the impact of frontal hypometabolism on the risk for nursing home placement and neuroleptic medication use. 2. Dr. Sultzer will complete additional focused training in PET methodology and neuroimage analysis, will supervise fellowship trainees at UCLA in their research projects, and will become a faculty expert in the phenomenology , pathophysiology, and treatment of psychiatric symptoms in AD.